Kids in (the RIGHT) Car Seats

I made this video starring all three of my boys to demonstrate the dangers of moving a child to the next, less protective, level of child restraint too soon.




Please share!

Guest Post: 8 Tips for Sleeping Comfortably During Pregnancy

Today we have a guest post from Scott Smith, a sleep counselor who advises on sleep and mattresses. He provides some tips for getting comfortable in bed during the different stages of pregnancy.

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Normally, the human body only makes significant changes to itself about every seven years or so.  The only natural exception to this rule is pregnancy.  Within nine months, body parts change size, the sleeping position that used to be comfortable is no longer possible, and the body is under a different type of stress and strain that may need different support.

While it’s unrealistic to change your mattress at every new stage, there are some things that can make you more comfortable on the bed that you have, through each trimester of pregnancy. 

First Trimester Tips:

• During the first trimester, the outside of your body isn’t changing much, but the inside is.  This is a great time to prepare your bed for the coming months by adding a waterproof mattress protector.  This will protect your bed against uncontrollable morning sickness, weakening of your bladder control muscles, as well as if your water breaks while in bed.
• You may notice some breast tenderness that will make stomach sleeping uncomfortable.  Try to sleep on your side, and hug a pillow to your chest to keep your chest open.  Also put a pillow between your knees to keep your hips comfortable.

Second Trimester Tips:

• As your body starts to change, your sleeping will also.  Sleeping on your stomach, if it was still possible until this point, will now be out of the question.  Similarly, back sleeping will become uncomfortable as your developing baby weighs on your other organs.  Sleep on your left side for optimal blood flow and nutrients to your baby.  Laying on the left can also help your kidneys do their job, which can ease swelling in your extremities.  Follow the pillow tips above for more comfortable sleep.
• Some women feel increased sensitivity in their ribs and hips, and may be tossing and turning a lot at night.  If this is the case, think about adding a mattress topper to your existing mattress, to make it a little softer and to ease those pressure points.
• Acid reflux can be problematic starting in the second trimester.  If you don’t have an adjustable bed, consider purchasing a wedge to sleep on at night, to elevate your head and torso.  Also, avoid eating right before bed, as well eating acidic foods such as tomato sauce, spicy food, or citrus.

Third Trimester Tips:

• Back soreness and pain is par for the course in the third trimester, so you want to make sure that you’re on a mattress that is supportive enough, without being too firm.  Have your partner stand behind you while you’re lying on your side, to make sure that your spine isn’t curved.  Arrange pillows to support your spine, by either placing them under your stomach, along your back, or between your knees.
• With all that extra blood that’s pumping through you, it’s easy to become overheated.  Instead of one big comforter, consider using layers to keep yourself warm.  That way, you can throw off and put on layers at will to maintain your perfect temperature.
• It may be difficult to get out of bed if you’re at the end of your pregnancy, especially if the bed is very soft.  Put a heavy piece of furniture next to the bed to help you pull yourself out.  Also, perfect the “pregnancy roll”, and roll yourself out of bed instead of trying to sit up.

Pregnancy is a wonderful time, but it can also be quite uncomfortable.  Your body is not only supporting itself, but is also forming a new person.  You need to treat it well, let it rest, and promote comfort so that it can put its best towards your new baby. 

If you are considering purchasing a new bed before or during pregnancy, really look hard at what you’ll need both during this time, as well as after. 

Scott Smith is the author of DrSnooze and a Sleep Counselor who also advises on sleep and mattresses. Follow him @DrsnoozeMatt and visit his blog at http://www.drsnooze.com/blog/ or http://www.drsnooze.com/brands/comforpedic.html

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Are you finding it difficult to get comfortable in bed as your pregnancy progresses? Try out some of Scott's tips and let us know if they helped you! Do you have anything to add from your own experience?

Childbirth Choices Series Part II: Meeting Your Care Provider

This is the second in my Childbirth Choices Series, geared toward newly pregnant or planning-to-be pregnant couples with the goal of educating women and their partners about the many options they have when it comes to their prenatal and maternity care, including choosing a care provider, choosing where and how to give birth, and information about labor, delivery, and the immediate postpartum time. This is not meant to replace or substitute for a childbirth education class. Rather, it is intended to get women thinking about their options and making informed choices when it comes to their care throughout pregnancy and labor and delivery.

More articles in this series:
Part I: I've Just Found out I'm Pregnant; Now What?
Part III: Do I Need a Doula?
Part IV: What Will Happen at My Prenatal Appointments?
Part V: It's Almost Time to Have a Baby!
Part VI: Labor and Delivery

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So, let's talk about that first meeting with a potential care provider. What are you looking for in a care provider? How do you know if this person is the one you'll want to see throughout your pregnancy? How do you know this is the person you want to help you deliver your baby?

Your first meeting can be a simple "meet and greet" appointment even before you're pregnant, just to get a feel for the practice, his or her personality, how the office is run, and other general impressions, as well as a chance to ask specific questions relative to your situation. Your first meeting might be early in your pregnancy, when you're still looking for someone to help you through the rest of this process. Or, you might have a care provider you've been seeing for your GYN care, and this is your first prenatal appointment. Keep in mind that often the first prenatal appointment isn't until you're 8 or 9 weeks along, so there will be some time for you to think about your concerns and questions you might want to ask. Your pregnancy will  be pretty well established by the time you have your first regular prenatal appointment.

Depending on whether this is a meet-and-greet or a prenatal appointment, the atmosphere of the meeting may be different. I'll start with the universals, things you'll probably want to ask or judge your impressions of no matter what. I'll then move on to a typical "first appointment" scenario.

What kind of provider are you looking for?

We discussed in the previous article the three basic options for a maternity care provider (CP). These were a certified nurse-midwife (CNM), a licensed midwife (LM/CPM), or the most common choice, an obstetrician (OB). Now I want to look at the type of person or personality you might be looking for. 

We all have different expectations when it comes to someone who will be providing us with medical care. Some may prefer a certain clinical distance: you don't want your CP to be your friend, you want your CP to be professional, reserved, authoritative, and objective. Others prefer a warmer or friendlier relationship: you want someone you connect with on a personal level, someone you'd like to go out for coffee with. Still others might like a mix of the two: someone you feel meshes with your personality, sense of humor, and style, but who still maintains a comfortable distance. Remember that this person will become fairly intimately involved with your most private and sensitive of areas, so you want to make sure that you are personally comfortable with him or her, however that comfort is manifested for you. You should think about what kind of personality you're looking for as you prepare for your first meeting so that you can assess whether this person meets that need. Since you'll be seeing this person fairly regularly for the next several months, you don't want to dread your appointments because you don't "like" him or her!

Male or female?

While most midwives are women (probably over 99%), there are about the same number of male obstetricians as female. Female doctors are increasingly joining the field of obstetrics, and many patients prefer a female obstetrician, for various reasons.

I have been equally happy (and in some cases equally dissatisfied) with male and female CP's over my four pregnancies. Several of the most celebrated obstetricians in the natural birth community in my local area are male. I don't think you can make any kind of sweeping generalizations about male or female practitioners being "better." It's really about your personal preference.

Why a woman?

Some women are simply more comfortable being unclothed in front of another woman. This is quite understandable. You may also feel that a woman will have more empathy for your situation, especially one who has given birth herself. You may feel a certain sisterhood with her, or feel that her personal experience is to her benefit as a practitioner. You may feel more comfortable discussing intimate problems with a woman, because you feel she may have "been there" herself, or that she will understand why it's difficult for you to talk about. There's a peer relationship you can have with a woman that you can't necessarily have with a man.

Why a man?

Some women feel that a male practitioner will have a more objective view of the process. Having not experienced childbirth or other "woman problems" directly may mean that he will view your situation with a clinical eye not clouded by feelings. You may feel he is better able to distance himself from the emotions of the situation in order to give you the best objective advice. Indeed, does a cardiologist have to have had heart surgery to perform it? Does a pediatrician need to have children to take good care of yours?

What if I don't have a preference?

Some women don't have a gender preference for their CP. Sometimes, you're just looking for the best fit, the person who is best at the job at hand and who meshes best with your expectations. You may feel going in that you couldn't possibly be examined by a man but then find that the woman you choose is not as empathetic as you hoped. Or, you may think that you prefer the objectivity a man will likely provide, only to find that his approach is too clinical and you prefer a warmer touch. There's no way to generalize. Midwives and doctors are human, too, and their practice is colored by their training, their background, their personal experiences, and their personal biases. That's why it's prudent to have an open mind when interviewing or meeting with your practitioner.

Group Practice or Individual?

We talked about the different advantages of a group practice versus an individual practice in the previous article as well. 

If you're going with a group practice, it's a good idea to try to make appointments with each of the available providers throughout your pregnancy so that you'll get a chance to meet everybody. In a group practice, you would hope that there's a unifying philosophy among the members of the practice. However, each doctor or midwife in the practice may have a different style and will certainly have a different personality, and you may find you simply "like" some of them better than others. It's up to you to decide whether you can be comfortable with whoever ends up attending your delivery. I was with a group practice in my first pregnancy, and I definitely found I preferred two of the doctors over the other two. Toward the end, we scheduled all of the appointments with our "favorite" doctor, but he didn't end up being on call for the delivery. But, we were comfortable enough with the level of knowledge and competence, as well as the personalities, of each of the four doctors that we were willing to "take what we got" when it came time to have the baby. 

With an individual practicing on his or her own, a major concern will be whether this is the person who will attend your birth. Some individual practitioners cannot guarantee that they will be available or on call when you go into labor, while others make it a point to be there. This is something you'll definitely want to find out early on! If your doctor or midwife can't be there for the delivery, then whoever is on call at the hospital or birth center will be there for your birth.

What do I want to know?

Okay, so what questions should you be asking, and what information should you be sure to acquire? Well, there are a few things you'll definitely need to know. 

• Where will I deliver my baby? What hospital or birthing center does this CP deliver at? (For a home birth, this is obviously not a relevant question.) 
• Who will deliver my baby? This goes back to the on-call situation: are you the one who will be there when I call to say I'm in labor, or is there no guarantee? If you are not available, who can I expect to see? Do you have arrangements with another practice to work with you for backup, or am I stuck with whoever is on call? How much of an effort do you make to be there personally?
• What is your cesarean section rate? This question applies to OB's, since midwives can't perform c-sections. Midwives in birth centers and the home-birth setting will instead have a "transfer rate" - that is, how often the patients in their care need to transfer to the hospital for emergency care. This is something you will want to find out if possible. Knowing if your OB has a relatively high c-section rate (the national average is about 32%, which most experts agree is too high) or a relatively low one may help you decide if you feel you are in capable hands. An OB with a lower rate is probably more "hands off" in the birth process, more inclined to let things happen naturally. An OB with a higher rate may be more likely to err on the side of caution if there are any concerns during the labor process. Remember that OB's who handle more high-risk cases will likely have higher c-section rates by virtue of their type of practice and not necessarily because of their philosophies.
• What kinds of recommendations do you make for managing the pain of labor? This is going to be a big question. What you're trying to find out is, how likely is this person to immediately turn to medical interventions such as epidurals and IV narcotics before or instead of trying non-medicinal methods of labor relief, such as breathing, changing positions, shower or bath, and relaxation techniques. Is this a CP who is more likely to let labor progress on its own, or is he or she going to recommend interventions early on? How do you as the patient feel about that? Are you more interested in "letting nature take its course," or do you feel strongly that you want an epidural the second you walk into the hospital? Are you more comfortable with laboring in more hands-off environment, or are you nervous about laboring without monitoring and assistance? These are very, very important questions for you to consider as you progress through your pregnancy, and we will definitely be addressing the issues of interventions, medications, and monitoring in a future article in this series. How your CP answers this question will help you understand how he or she views the birth process and how you as the mother will be treated.
• What is your (or the hospital's) policy on continuous fetal monitoring? Continuous fetal monitoring (CFM) means that you would wear a fetal heart monitor strapped to your belly at all times. This is a tool that we will discuss in more detail in a future article. You may want to know if you will be required to wear this monitor at all times, as it may limit your mobility and ability to change positions or use alternative pain relief options such as a shower/bath, and CFM has some unexpected risks, such as increasing your chance of emergency c-section. You may want to follow up on this question by asking if intermittent monitoring is an option. In this scenario, you'd wear the monitor for 20 minutes every hour and otherwise be disconnected and free to move about, if you want.
• What is your policy on eating and drinking during labor? What is your (or the hospital's) policy on the use of an IV? Labor can be long and uses a lot of your energy. Many CPs and/or hospitals will not permit a laboring woman to eat or drink during labor in case she requires an emergency c-section and emergency anesthesia. You will want to know if you'll be allowed to bring food and drink with you to fuel your labor. Often, if your provider or birth location has a policy against eating and drinking during labor, they will require you to be on an IV for fluids at all times to prevent dehydration in you and the baby. They may also prefer to have an IV ready in case any medications such as antibiotics or Pitocin are deemed necessary.
• How do you feel about my having a doula? Even if you don't plan to hire a doula (and we'll talk about doulas in a later article, too, never fear!), you may want to know whether your CP is open to your having a labor coach or additional support in the room with you. A "doula" may also simply be a friend or family member who is there to encourage and support you as you labor. Most CPs, birth centers, and hospitals are amenable to the presence of a labor support person other than the baby's father or a close family member, but some are not. Knowing your CP's attitude on this subject may be informative for you.

These questions should help you gauge your potential provider's approach to labor and birth so that you can determine if these ideals are in line with your own. We will be getting into considerably more detail about many of these topics in future articles, to help you gauge your own birth preferences, as well!

Your First Prenatal Appointment

This is a description of what typically goes on during a first prenatal appointment, especially in a more traditional setting, just to give you an idea of what to expect.

You'll first be asked to fill out some paperwork about your general health history and gynecological history specifically, especially previous pregnancies and births, if applicable. Your provider may have these forms mailed to you in advance of your appointment so you can arrive with them already completed, or you may be asked to fill them out when you arrive. You'll probably need addresses and phone numbers to use for emergency contacts, how to contact you and your partner at work, your insurance information, and so on. You may also want to have on hand information about previous GYN care providers and be prepared to have your records transferred if you are moving to a new provider. It's important that your provider has a picture of your medical history so that they can care for you appropriately. Conditions such as diabetes, hypertension, thyroid issues, psychological disorders, and various GYN problems will likely be relevant to your treatment during pregnancy and delivery and possibly postpartum as well.

You'll probably be asked to provide a urine sample (by peeing in a cup), which will be quickly tested for protein and glucose content. The presence of protein in your urine could signal kidney problems, which would need to be evaluated. Glucose in the urine may indicate diabetes or the potential for diabetes, which would need to be managed.

You'll then be taken to the exam room. Your provider will most likely want to perform a full gynecological exam. For this, you'll be asked to take off all of your clothes, and you'll probably be given either a hospital gown or a paper vest and towel to put around yourself. (From personal experience, I recommend keeping your socks on if you're wearing socks - sometimes the room is cold, or the stirrups are uncomfortable on bare feet.) The care provider will examine your breasts and genitals and do a quick internal vaginal examination with gloved fingers and possibly a speculum to check your cervix and feel for your uterus and ovaries. If you have had a gynecological exam before, this should all be familiar to you.

Many care providers will then perform a transvaginal ultrasound to "see" the pregnancy. An ultrasound machine measures the way high frequency sound waves bounce off various structures in your body and creates a live picture on a computer screen of the tissues, organs, and bones the sound waves encounter. The provider can manipulate this picture to focus on the organs of interest, in this case your ovaries and uterus, and to view the growing fetus. You may be familiar with a traditional ultrasound machine, which uses a wand and some gel on your abdomen. For this type of ultrasound machine to get a clear picture, you generally need to have a full bladder. A transvaginal ultrasound, by contrast, uses a wand that is covered by a lubricated condom and inserted into your vagina. It does not require a full bladder to get a clear picture of your uterus, cervix, ovaries, and the baby. The provider will use the ultrasound machine to take measurements of the fetus and look at the heartbeat as well as to check the placement of the pregnancy to make sure everything looks healthy. Based on the measurements on the ultrasound, your CP can get a pretty good idea of how many weeks and days the baby has been growing, and from there determine whether your estimated due date, based on your last menstrual period, is accurate or if an adjustment needs to be made. If the estimate from your ultrasound and your last menstrual period are within a few days of each other, your due date will probably not be changed. If there is a larger difference, they may want to change the date based on the baby's actual growth.

If you are not comfortable with the idea of an ultrasound in general, or a transvaginal ultrasound specifically, you should bring up your concerns with your provider. It is your right as the patient to refuse any procedures you feel are unnecessary or carry unreasonable risk to yourself or your baby. Though it is a useful tool, an ultrasound is not necessary to date or assess the pregnancy. You should feel comfortable asking your provider what the purpose of the procedure is and whether and why he or she feels it is important. While you may not be able to hear the baby's heartbeat using external methods (such as a Doppler machine or stethoscope) at eight or nine weeks, by about 12 weeks it is possible to hear the heartbeat using noninvasive methods, and you may be more comfortable simply waiting to use a less intrusive method to hear the heartbeat. On the other hand, you may be excited to get to see your baby so soon (no, you can't see the gender this early!), and seeing the little heart fluttering on the screen is very reassuring.

You will also be given information about certain blood tests your CP recommends. These will include general blood tests such as checking your blood type, measuring your iron stores, thyroid function, and white blood cell count. Your CP will also likely recommend that you be tested for antibodies to certain diseases such as chicken pox, measles, rubella, and other viruses that may be dangerous to a growing fetus. If you have had any of these diseases in the past, or you have been vaccinated against them, there should be nothing for you to worry about. There is a blood test, as well, to look for certain chromosomal abnormalities in the fetus, specifically Down syndrome. Your CP will ask if you would like to receive this testing and give you information about how it works and what they look for.

Your CP will also discuss with you whether you want genetic testing to find out if you are a carrier of any known genetic diseases such as cystic fibrosis, sickle cell anemia, or Tay Sachs (depending on your ethnicity and risk of being a carrier). If you are a carrier of a genetic disease and the father of the baby is as well, there is typically a one in four chance that your baby will have that disease. You may want to know whether your baby is at risk of having one of these terrible genetic disorders. Some people choose to be tested for this before deciding to have a baby, but often you don't know about them until you are pregnant. If anything is found, you can receive genetic counseling to help you decide what to do and how to handle future pregnancies.

Remember, again, that you have the right as the patient to refuse any tests or procedures you are not comfortable with. For example, if you don't think that knowing the results of a genetic test would change your desire to carry your pregnancy to term, then you may want to decline the testing. On the other hand, knowing about a potential disability or disease may be important to you, even if you still plan to carry the pregnancy to term, so that you can be prepared with services and support when the baby is born. You probably want to discuss this decision with your partner to make sure you both feel the same way.

Your next appointment will likely be scheduled for four to six weeks in the future, and you will probably be asked to have your blood tests in the meantime. Some blood tests need to be taken during a specific time frame for accuracy.

Your provider will then likely discuss with you some issues such as exercise and diet and what you can expect in the next few weeks. You should be given an opportunity to ask any questions you may have and air any concerns that have come up.

If, for any reason, during your appointment, you feel uncomfortable, you should let the provider's office know via a phone call or, better, a letter. If it's in writing, you have evidence of what you said. If you do not wish to return to see this provider, start looking for a new one quickly so you can schedule your next appointment, and arrange to have your records sent over to them. You also have the right to request a copy of your records to keep for yourself if you want. The provider's office may charge a copying or processing fee, usually not more than $25, for the time and supplies used by the office staff in copying the records, but they are not allowed to refuse to give them to you.

If this is not your first pregnancy and there was anything of note or unusual about your previous pregnancy(ies) and/or delivery(ies), you may also want to request your hospital records from the birth(s) so that your new provider will know about these circumstances. That information can be valuable in planning your next birth.

Stay tuned for the next article in this series. If you have any questions about this or any of the topics covered in the Childbirth Choices Series, feel free to comment below or on my Facebook page, or send me a private message via the Facebook page.

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More articles in this series:
Part I: I've Just Found out I'm Pregnant; Now What?
Part III: Do I Need a Doula?
Part IV: What Will Happen at My Prenatal Appointments?
Part V: It's almost Time to Have a Baby!
Part VI: Labor and Delivery

Know How To Remove and Install Your Car Seats!

We bought a minivan last Thursday. What a relief it is to no longer have to stress about fitting three car seats across the back seat, of squishing my tall six-year-old into the tiny third row of our SUV, of having to choose between my kids' safety and space for groceries! I'm loving it! As part of the purchase, I opted to have them do fabric and paint protection. Having (eventually) four kids in the car will do a number on the upholstery, and I hope that having the protection will help when it comes to inevitable spills and whatnot.

This necessitated my bringing my brand new van back to the service department and leaving it with them for the day and taking a rental car instead.

So, in the past week, I have taken two car seats out of the old car, installed them in the new car, then taken them out of the new car, installed them in the rental, taken them out of the rental, and re-installed them in the new car. All at 20 weeks pregnant, I might add.

G likes the new van.

And this brings me to my major point today. It is very important that you know how to remove and re-install your car seats properly.

While I often recommend that you have your seats installed and/or checked by a Certified Passenger Safety Technician (CPST) near you (often found as a free service through your local police or fire station or hospital), you also must know how to manage your car seats on your own. There will inevitably come a time when you need to move your car seat(s) from one car to another, or take them out to clean them or the car, or rearrange them.

1. Have your seats professionally installed at least once.
If you have the opportunity, absolutely have your car seats installed and/or checked by a CPST. This will reassure you that your seats are, in fact, being used correctly. If you make any changes, such as switching from an infant carrier to a convertible seat, or turning a rear-facing car seat to face front, or adding a second car seat, you may want to return to the CPST and have them reinstall or recheck your new configuration.

2. Ask the CPST to SHOW YOU HOW to install the seat yourself.
While the CPST is doing the installation, watch what they're doing. A good CPST will show you how to fasten and lock the seat belt or use the LATCH connectors, how much to tighten the belts, and how to tell if you have a good install. S/he should also be able to show you how to correctly buckle your child into the seat. If you can, take pictures of how the seat looks when it's correctly installed.

3. READ YOUR MANUAL.
While there are some generalities we can make about car seats, each one may have some slight differences in the details. You should be familiar with your manual, know where to find it (if you can't find the one that came in your box, most companies have them available online for download), and read the instructions when attempting to remove or install the seat by yourself.

4. Know these general rules.

• Use LATCH or seat belt, but NOT BOTH to install the seat.
• Make sure you use the proper belt path for forward or rear-facing. This path should be marked on the side of the car seat itself.
• Make sure the LATCH or seat belt strap is not twisted as you feed it through the belt path.
• When forward-facing, you MUST use the top tether. If there is no hook for the top tether in the location you have chosen, then you cannot install the seat in that position.
• The LATCH or seat belt should be tight enough that you cannot jiggle the car seat more than ONE INCH side-to-side or forward and back.
• If using the seat belt, make sure that it is LOCKED. In newer cars, this simply means you should pull it all the way out and then let it retract. Tug on it to make sure it is locked.
• Look in both your car seat manual and your car's manual to check if the LATCH has an upper weight limit. If your child has reached this limit, you MUST install with the seat belt and stow the LATCH connectors.

Remember that the best car seat for your child is one that is installed and used correctly!

Ultrasound Results!

I suppose it's only fair to tell you that the ultrasound results are in! Here's the "revealing" picture!

Can you tell?

Yes, that is indeed a penis. That means a house full of four boys is in my future!

So my fears about having a girl have not been realized, and yet my fears about having four penises to worry about are in full force.

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Some General Early Pregnancy Information and Advice

I started writing this as the second in my Childbirth Choices Series, and found that I was bursting with information to share about pregnancy, especially the early days. (Hey, I've done it four times, after all!) It doesn't seem to fit into the framework of the Childbirth Choices Series, but I wanted to make the information available. If you are thinking about trying to conceive or you've just found out you're pregnant, this post will probably be very informative. I've organized it by topic, so you can skip around to the specific questions you may have; you could also just read it top to bottom, of course, or come back and revisit sections as you go along. This would be especially good to read before your first provider appointment, since there will likely be some time before your first meeting. Often, you won't be seen until you are about eight or nine weeks along. If you are still trying to decide on a provider (and I hope my Childbirth Choices Series Part I post is helpful in that regard), you may try calling a few providers and asking if you can schedule a "meet and greet" before your first appointment - or even before you're pregnant - so that you can get a feel for their personality, the way their office is run, and ask any questions you have about their policies and practice.

Remember, also, that if after your first appointment you find that you're not comfortable with the person you met - for whatever reason! - you can switch to someone else. Your provider works for you, and you're under no obligation to remain with the practitioner you see initially.

Let's look at some common questions first-time parents have.

**Please note that I am not a medical provider  or practitioner. This advice is based on personal experience and research only. If you have any concerns, please contact your maternity care provider or general physician.**

How is my due date calculated? How "far along" am I?

In the early 19th century, a German obstetrician named Franz Naegele came up with a rule for estimating when a woman can expect to go into labor. The calculation is 280 days (40 weeks) from the first day of the woman's last menstrual period. This measurement is still used today as the standard calculation of your EDD - your estimated due date. If you know the date that your last period began, you simply count 40 weeks from that date on a calendar. Wherever your finger lands, that's your EDD. You can also find dozens of calculators on the internet that can help you do this. Just type "due date calculator" into your favorite search engine and one will pop right up. These will typically simply ask you for the date your last period started and then return your estimated due date. If you don't know the exact date of your last period, or you have a very irregular cycle, it may be difficult to estimate your due date. Some women have a sense of when they conceived. You can also use this date to find out your due date. Simply count 38 weeks from that date. If you really have no idea, then your provider can use a transvaginal ultrasound at your first appointment to take a look at the fetus and estimate its gestational age based on its size and development. From the gestational age, they can calculate a due date.

Please remember that 40 weeks is an estimate, a convenient and standard measurement to gauge the length and health of the pregnancy. Many, many pregnancies progress beyond the 40-week point, and it is normal to continue even on to 42 weeks without complications or danger to you or your baby. Your provider will want to monitor you and the baby if your pregnancy goes "post-dates" or overdue (beyond the EDD), but you should be aware that the average first pregnancy may run as long as 41.5 weeks. A "full term" pregnancy is considered one that runs to at least 38 weeks before the spontaneous labor begins.

Some definitions before we continue:

LMP - Last Menstrual Period - Use this date to find out how long you've been pregnant. Count the number of weeks and days since the first day of your last period. For example, if your last period began on January 15 and it's now April 1, you are 10 weeks and 5 days pregnant, often abbreviated 10w5d. Also use this date to find out your EDD by counting 40 weeks from that date.

EDD - Estimated Due Date - The date 40 weeks from your LMP, or a date chosen based on the measurements obtained in an early transvaginal ultrasound.

Transvaginal ultrasound - Your provider may use a special ultrasound machine to confirm and date your pregnancy. This machine has a computer screen and a probe that she or he will insert into your vagina. The probe emits sound waves which bounce off structures inside your body, creating a picture on the screen. Your provider will use this to find the developing fetus in your uterus. You will be able to see the heart beating, and the provider will take measurements to estimate the age and size of the fetus. These estimates will be compared to the EDD based on your LMP (if you know it), and your due date may be revised if there is a large discrepancy between the two estimates. An ultrasound may also be used if any problems are suspected, to check the placement of the pregnancy (ensure that it's in the uterus and not in the Fallopian tube, which called an ectopic pregnancy and is life-threatening to the mother), and to view the heart beat, since it cannot be heard externally early in the pregnancy. Your provider will likely print off a few pictures for you to keep. At about 8 to 9 weeks, the baby will look like a peanut in the ultrasound picture.

Gestational Age - The gestational age is how "old" your baby is inside the womb. "Gestation" is the length of the pregnancy. So the gestational age of your baby is how long you've been pregnant. 

So, when someone asks you how far along you are, you can give them the number of weeks and days since your LMP, if you want. You can also estimate how many months until your due date and subtract that from nine if you want to give a more vague answer. So, if you're due at the end of October and it's now mid-May, you can say that you're about four months along. (There are five months from May to October. Nine minus five is four.)

This can be confusing, because you aren't actually pregnant yet when your period starts (obviously). Your date of conception is hard to guess. Even if you had intercourse exactly once in the past few months, and know this exact date, that is probably not the date of conception, since it can take one to five days for the sperm to encounter and fertilize the egg. Since the LMP is a more exact date, it is easier to calculate from that point. Especially if you have an irregular cycle, you may have no real idea of when you actually ovulated.

Spontaneous labor - Most of the time, your labor will begin on its own when your baby is ready to come and your body is ready for birth. When you go into labor without any assistance or intervention from medications, this is called "spontaneous labor." Spontaneous labor after 38 weeks is considered a full-term pregnancy, and your baby should be fully grown and ready to face life outside the womb. If you go into labor before 38 weeks, your baby may be considered premature and may need medical assistance in the early days of life. If the labor begins very early in the pregnancy, your provider may recommend attempting to stop the contractions and take measures to put off the birth as long as it is possible and safe for you and the baby to do so.

When should I announce my pregnancy?

You may want to wait some time before you announce your pregnancy. This is normal and expected, and the reason is simple: miscarriages in the early weeks are quite common, occurring in about 10 to 25% of pregnancies. I don't want to sound negative or tempt fate, but if you've happily announced your pregnancy to everyone you know, only to suffer a miscarriage, it is no fun to have to figure out who knows and go back and tell everyone "never mind." Not to mention the pain of having someone asking when you're due or how far along you are now because they didn't get the message. Most women wait until at least the first prenatal appointment, when the health of the pregnancy can be assessed, or even until after about 12 or 13 weeks, when the risk of miscarriage drops considerably. And, some families choose to wait until the pregnancy starts to show, which can be as late as four or five months, or even longer depending on how you're carrying. You may want to choose a trusted family member or friend to tell sooner in order to get support and advice, especially if it's your first pregnancy.

What are the early symptoms of pregnancy? What can I do to feel better? How long does morning sickness last?

Here is a list of symptoms you may or may not experience in the first few months of pregnancy. Some women experience all of these, while others experience none. You may also experience symptoms that are not on this list. They may or may not be caused by the pregnancy. We tend to attribute anything "weird" to the fact that we're pregnant, even if it's actually just something we ate!

• fatigue
• insomnia
• constipation
• frequent need to pee
• nausea and/or vomiting
• heartburn
• food aversions (feeling disgusted by eating or smelling certain foods that you'd normally enjoy)
• food cravings (sudden overwhelming desire to eat certain foods or types of foods)
• increased appetite
• decreased appetite (if you're feeling especially nauseous)
• sore/tender breasts
• sensitive/sore nipples
• irritability or mood swings
• a feeling of tugging or pulling in your lower abdomen
• lower abdominal pains or uterine cramping
• low back pain
• vaginal dryness or itching
• increased vaginal discharge
• vaginal yeast infection or bacterial vaginal infection
• stuffy nose
• heightened sense of smell
• bizarre and vivid dreams
• decreased libido

Morning Sickness

The hallmark of early pregnancy is, of course, "morning sickness." Morning sickness affects many women in the first three months or so of pregnancy and is usually characterized by nausea (the feeling that you're going to throw up) and/or vomiting, especially in the morning or on an empty stomach. (You typically experience it more in the morning because your stomach is empty.) If you talk to other women who have been pregnant, or you look on the internet, you'll find numerous "remedies" for morning sickness. Like hiccups remedies, some of these work for some people, while others simply suffer no matter what they try. 

Here are some general tips for managing mild to moderate morning sickness that I've found helpful through four pregnancies:

• Eat! Even though you don't feel like it, the nausea is usually worse on an empty stomach. If you can eat a few crackers or something before the nausea sets in, sometimes you can head it off.
• Stay hydrated! The nausea is worse when you're dehydrated. Also, if you are vomiting more than once or twice a day, you're probably losing fluids, and you need to make sure you're replenishing them.
• Some foods help some women find relief from nausea. These include ginger, almonds, ginger ale, crackers, or toast.
• Motion sickness wrist bands help some women.
• Eat what you crave. This may sound odd, but sometimes you'll feel better if you just eat what you feel like eating (unless you are craving a non-food item, such as chalk, dirt, or ice. This is called "pica," and can be indicative of a vitamin or mineral deficiency. If you experience pica, contact your provider).

For most women, morning sickness goes away around 14 or 15 weeks of pregnancy, when you enter the second trimester and your hormonal balance changes. Some women find that they are sick for most or all of their pregnancy. If you feel you are experiencing excessive morning sickness, especially if you are losing weight, you may want to contact your provider for advice or an earlier examination.

Hyperemesis Gravidarum

For some, perhaps 2% of pregnant women, "morning sickness" is very severe. They may vomit multiple times a day, experience rapid or severe weight loss due to inability to keep down any food, extreme nausea, and severe dehydration due to inability to keep fluids down. This can be very dangerous to you and to your growing baby. These symptoms may last well beyond the first three months and may even continue throughout the pregnancy. Excessive vomiting in pregnancy is a medical condition called Hyperemesis Gravidarum (HG), which literally means "excessive vomiting of pregnancy". If you are experiencing these symptoms, contact your provider. Some women respond well to anti-nausea or anti-vomiting (antiemetic) medications, while others may require stronger interventions such as IV fluids or even hospitalization. If you have or think you have HG, you may find www.helpher.org helpful for information and support.

What is a trimester? What trimester am I in? What kind of symptoms can I expect in each trimester?

Pregnancy is about nine months long and is divided into three approximately three-month segments, called "trimesters." Each trimester has certain characteristics, and as you move from one trimester into the next, you will probably be able to tell that you've entered a new "phase."

The First Trimester

The first trimester runs for the first 12 to 14 weeks of the pregnancy. Your pregnancy may not show yet, but you may experience some of the symptoms listed above as "early" symptoms of pregnancy. (Some of these symptoms may continue on and off throughout the pregnancy.)

Many early pregnancy symptoms will be similar to the symptoms you experience just before or during your period. I don't want to scare you with that list. Like I said, you may experience some or all of these symptoms. You may not have any of them, and some lucky few will have all of them. They may come and go throughout the weeks. And sometimes they may be there but not bother you that much, or you'll get used to it. The absence or presence of any or all of these symptoms is not a measure of how healthy your pregnancy is.

Toward the end of the first trimester, or perhaps early in the second trimester, your care provider will be able to start listening to your baby's heartbeat externally using a stethoscope or Doppler machine. It is fun and reassuring to hear the heartbeat thump-thumping away at each prenatal visit!

The Second Trimester

The second trimester runs from about 12-14 to 28-30 weeks of pregnancy, the middle three months. The second trimester is usually the most pleasant phase of pregnancy. Your body will start producing hormones that give you a sense of well-being and excitement about your pregnancy. Many of the early symptoms will fade, especially morning sickness for most women, and you should have more energy. Your pregnancy will likely start to show sometime in the second trimester (if it doesn't show already), and you'll probably begin to tell people about it. You should find that some of the insomnia fades as well. Your strange and vivid dreams may continue, as will your enhanced sense of smell and some other symptoms. By the beginning of the second trimester, your breasts have begun manufacturing and storing colostrum, the early milk that will nourish your baby for the first three or four days after birth. Some women may experience a small amount of colostrum leakage, seen as a yellow crust on the nipple or in your bra, although this doesn't typically start until the third trimester, if it happens at all (all of these scenarios are normal). Your breasts may still be tender. You may find you have an increased libido (which should please your partner) in the second trimester as well, and your breasts will likely have become noticeably bigger.

In the second trimester and forward, you'll want to avoid lying flat on your back for long periods of time. The uterus is getting bigger and heavier and will put pressure on the vena cava, a major vein carrying blood from the lower half of your body back to the heart. You may start to feel light-headed or uncomfortable if you lie on your back. Lying on your left side is the best position for maximizing blood flow. If you find you've rolled onto your back while sleeping, don't panic! Just roll to one side or the other (preferably the left side) once you become aware of your position.

Try not to overeat. Especially when or if your morning sickness goes away, you may find that you are hungrier than you're used to being. You are expected to gain some weight during pregnancy - up to 25-35 pounds by the end. I'm not here to tell you to diet or starve yourself, and I'm not able to give you specific nutritional advice. But be aware that you are not actually "eating for two" - pregnancy consumes approximately 300 more calories per day than you would need if you were not pregnant, so plan your meals accordingly.

The best part of the second trimester is that at some point you'll start to feel the baby moving and kicking. You can start feeling this as early as 14-15 weeks and as late as 22 weeks, depending on your size, how you're carrying, the baby's position, and the location of your placenta. (If the placenta is anterior - in the front - then it will block the sensation of kicking until the kicks become stronger.) At first, these "kicks" will feel like little twitches in your abdomen. Most women compare them to feeling like gas bubbles or minor muscle spasms. After a while, they'll become unmistakable as coming from the baby, and you'll enjoy knowing that your baby is busy in there. Your provider may ask you to do "kick counts," which just means to make sure you feel 10 movements in one hour each day, just to make sure the baby is okay. If you go a day without feeling any movement, you may want to try drinking a glass of ice water or orange juice and paying close attention. It may be that you were just distracted from baby's movements, and a glass of cold, cold water or orange juice will encourage the baby to move around so you can be sure everything's okay. Your provider will tell you at what point you should call if you are concerned about a lack of movement.

Sometime during the second or third trimester, you may become aware of mild but strong contractions, usually not painful, in your uterus. Since early pregnancy, your uterus has starting contracting occasionally to "warm up" for the big day. These contractions are normal and are called "Braxton-Hicks" contractions. If these become strong or bothersome, you may want to try drinking at least three glasses of water and then lying down on your left side for a while. Sometimes you may experience strong contractions if you are dehydrated and/or tired. If you experience four or more strong contractions in one hour, or the contractions develop into a regular pattern that lasts for more than one hour after you've made sure you're hydrated and rested, you should contact your care provider to see if you need to have your cervix checked or what your next step should be.

The Third Trimester

The third trimester is the final three months of the pregnancy, running from 28-30 weeks to the onset of labor or delivery of the baby, generally between 38 and 42 weeks. The third trimester is can be fairly uncomfortable. Your belly is getting bigger and your baby is getting heavier, which may cause more aches and pains, especially in your back and legs. Your fatigue and insomnia may return, partly because you find it more difficult to get comfortable in bed. You may experience some swelling in your hands, feet, and ankles. You will probably need to pee more often, because the baby is putting pressure on your bladder. You may also experience pain and pressure in your pelvis or hips. During pregnancy, your body releases a hormone called relaxin that causes your joints to loosen up so that your pelvis can expand for delivery of the baby. This can cause other joints, such as your hips, knees, ankles, and wrists, to also become more injury prone. You may find that you have to stand up more carefully or that you develop soreness in your wrists, especially if you work at a repetitive motion job such as typing. It is fairly common to experience carpal tunnel syndrome, for example, during pregnancy.

In the third trimester, you'll want to pay close attention to your posture. When you stand up straight, you don't want to allow your back to curve inward too much - this will cause your lower back to hurt more. Let your bottom drop a bit to rotate your hips toward your back slightly. You'll know when it feels right. Also, if you wear a shoe that has a slightly raised heel (about 1 to 2 inches), this can be quite comfortable. There are products that can help support your belly if your back hurts badly as well. When you sleep, you can stick a pillow between your legs when you lie on your side, and you can support your back and belly with pillows as well to find more comfort.

Can I exercise when I'm pregnant?

Yes! If you had a regular exercise routine before you became pregnant, you can probably continue with this routine during your pregnancy. You may need to modify some of your activities depending on how strenuous they are or how much pressure they put on your abdomen. Some activities may become impossible, impractical, or dangerous to the baby due to potential falls, such as biking or horseback riding. If you're a runner, you will want to be careful, as your balance will be affected by the changes in your center of gravity as your baby grows. Swimming is excellent exercise while pregnant, as are yoga (with modified poses for pregnancy), pilates (again, modified for pregnancy), and walking. If you have not had a regular exercise routine before becoming pregnant, don't start something intense or strenuous that your body is not used to doing. Starting a walking routine or some other type of low-impact, low-stress exercise is very beneficial both for weight management and your overall health and feelings of well-being. In addition, being active during your pregnancy will help settle the baby into a good position for labor and delivery.

When you exercise, pay attention to what your body is telling you. Make sure you don't allow yourself to overheat and stay well hydrated. If you find you are getting sore or tired, stop. You may not be able to do as much or exercise for as long as you could before you became pregnant. If you find that you are having contractions, stop, drink two or three glasses of water, and lie down on your left side for a while. Contractions are usually triggered by exhaustion and dehydration, and if it is not time for you to give birth, you need to heed your body's message that you need to rest. If you notice any vaginal bleeding, stop what you're doing and call your care provider. If you have any questions or concerns about your exercise routine while pregnant, talk to your care provider.

When should I contact my provider?

Any time you have a concern, you should feel comfortable calling your provider. Your provider should also give you some general guidelines as to when you should definitely call. These may include (but are not limited to)*:

• regular contractions, at least four in one hour lasting at least 30 seconds each
• vaginal bleeding (some light spotting in the early days is fairly normal, but heavy bleeding is not)
• excessive vomiting, inability to keep food or liquids down
• severe abdominal cramping or back pain
• sudden severe headache and vision changes
• sudden swelling in the ankles and hands
• lack of movement from the baby for 24 hours after you've started feeling regular kicking

*Please remember that I am not a licensed medical professional and cannot give you specific medical advice. If you have any concerns about your pregnancy or you want to know if something you are experiencing is normal, please contact your provider!

What should I stop eating? What should I start eating?

For the most part, you can maintain your usual diet while pregnant. You want to make sure you're getting enough vitamins and minerals, especially B vitamins, folic acid, calcium, and Vitamin D. Taking a prenatal vitamin or other vitamin supplements can help. Since pregnancy can make you prone to constipation, make sure you drink enough water and get plenty of fiber. If you're not sure whether you need to make specific changes to your diet, of course speak with your care provider. You may find that you're hungrier than you normally would be. Building another human takes calories, but pregnancy typically takes only about 300 more calories than you'd need in a day if you weren't pregnant. This means you don't need to increase your food intake by much - you are certainly not eating for two. The bulk of those extra calories should be from healthy foods, if possible!

There are a few foods to think about minimizing or eliminating while pregnant. While your system may be strong enough to handle food-borne toxins and bacteria, your baby's may not be. Foods that you may want to avoid for this reason include unpasteurized soft cheeses, processed deli meats, and raw sushi (you can still eat vegetable sushi or sushi made with cooked fish). Tuna and salmon tend to contain high amounts of mercury, which may negatively affect your baby's development. Mercury is toxic and can cause brain damage in high doses, especially to the developing brain of a fetus. Mercury is considered to have a cumulative effect, meaning that the more of it you consume, the more you store in your body. For that reason, it is recommended that pregnant women eat no more than one to two 5-ounce cans of tuna per week. If you're nervous about mercury, you can simply avoid tuna, but do eat other fish if you can, because the fish oils are very, very good for you and your baby! Plenty of other fish are quite safe (when cooked, of course!), such as cod, haddock, tilapia, and mahi mahi.

What medications can I take while pregnant? Do I need to stop taking the medications I'm on?

As I am not a doctor or pharmacist, I can't speak about specific medications. However, it is useful to know that there are certain medications that are considered safe during pregnancy. Personally, I try to avoid taking anything unless I absolutely have to, but sometimes that headache or backache is just too much, or you have a bacterial infection, or you can't sleep because your nose is soooo stuffy or you can't stop coughing. In those cases, if less medication-oriented remedies don't help, you can contact your care provider for suggestions. In the past, I've had doctors and midwives tell me it's safe to take Tylenol (as directed on the bottle), Benadryl, and certain decongestants and expectorants. I've also taken certain antibiotics for sinus infections and UTI's during pregnancy. There are definitely medications that have been proven to be harmful to the fetus, and there are some that are suspected to be harmful. For example, ibuprofen (Advil/Motrin) is not generally considered safe during pregnancy.

If you are on a medication for a chronic condition such as a psychiatric disorder, high blood pressure, diabetes, or asthma, talk with your prescribing doctor and your care provider as soon as you find out you're pregnant - or even sooner if you're planning to become pregnant - to see if what you are taking is safe for the baby. You may have to weigh the relatives risks and benefits of taking a medication if it is essential for your own physical or mental health, and that is something you'll have to discuss with your doctor(s).

Why do I need to take a prenatal vitamin? Can I take a regular multivitamin instead?

It is important that you get enough folic acid while pregnant to prevent neural tube defects in your baby. The most well-known type of neural tube defect is spina bifida, which can cause severe disabilities or death in your baby. Taking 800mcg (micrograms) of folic acid daily can prevent spina bifida and other related disorders. Prenatal vitamins are specifically formulated with extra folic acid and a balance of other vitamins and minerals that you need as a pregnant woman. If you can't tolerate your prenatal vitamin (and they do make some women feel sick), you can talk to your care provider about taking a regular or gummie multivitamin or even a children's multivitamin, or you can ask if there are other options available. You will also want to make sure you are getting enough iron in your diet to prevent anemia. If you are having trouble with muscle cramps, a calcium-magnesium supplement can help as well.

What can you tell me about using alcohol and cigarettes while pregnant?

The general rule with alcohol during pregnancy is don't drink alcohol. This is because it is not known what the threshold alcohol intake is before it begins to affect the baby's development. For some women, it appears that just one drink can cause problems, especially if she has a history of heavy alcohol use. In my view, and in the view of most practitioners, it's easy enough to simply not drink alcohol and not take the chance. Fetal alcohol syndrome is real, and it's permanent, and it's preventable. In Europe, you'll find a slightly more relaxed attitude toward alcohol during pregnancy, but this is something you'll have to discuss with your care provider and do your own research on.

As far as cigarettes, smoking during pregnancy can cause a host of problems for your developing baby as well. Because smoking reduces oxygen to your baby, smoking during pregnancy can cause your baby to be of low birth weight, which may cause long-term problems. Smoking may also contribute to preterm birth, which can mean lengthy hospital stays and lifelong health problems as well. Smoking during pregnancy also increases the baby's risk of asthma and other breathing problems as well as the risk of SIDS (sudden infant death syndrome, also known as "crib death"). Nicotine may also cross the placenta and affect the baby's brain development. If you can quit, that would be the best option. If you're finding it too stressful to quit cold turkey, speak with your care provider about getting support and help with quitting, and try to cut back as much as you can, or go as long as possible between cigarettes to maximize the oxygen your baby gets.


Do you have other questions about early pregnancy you'd like answered? Comment below!